Healthcare Provider Details

I. General information

NPI: 1184172579
Provider Name (Legal Business Name): IVORY A. KINSLOW, MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 THOMPSON AVE
EL DORADO AR
71730-4569
US

IV. Provider business mailing address

300 THOMPSON AVE
EL DORADO AR
71730-4569
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-2340
  • Fax: 870-862-2548
Mailing address:
  • Phone: 870-862-2340
  • Fax: 870-862-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2574
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC7743
License Number StateAR

VIII. Authorized Official

Name: SHARON WINN
Title or Position: CEO
Credential:
Phone: 870-862-2340